The Significance of Rapidly Falling Blood Sugar

Q. In one of their books, Durk Pearson & Sandy Shaw said that you could arrest an unpleasant plunge in blood sugar related to reactive hypoglycemia by taking 2 grams or so of L-cysteine together with 3 times as much vitamin C (they also included some disclaimers as to the possible downside of this strategy). Does a similar strategy work with N-Acetylcysteine, which I happen to have on hand? If you have a resident expert perhaps they could comment on this or, if not, pass my question along to Durk and Sandy. I have had my blood sugar fall 50 points in 10 minutes, so this has been valuable information about L-Cysteine. Plus, orthodox medical people don't have a clue about handling such issues.

Patrick, Bloomington, MN

A. Dear Patrick,

Your recall is very good, regarding Durk & Sandy’s recommendations. I had to look them up. On page 482 of Life Extension, they explained that, “Cysteine can … block the effects of insulin in the serum and … abort the hypoglycemic effects of insulin. It does this by reducing one or more of insulin’s surface-exposed three disulfide bonds, thus altering the shape and function of the insulin molecule.”

On page 81 of their Life Extension Companion, they further explained that, “In hypoglycemia attacks, there is too much insulin and too little sugar in the blood stream. Cysteine can inactivate insulin, thereby allowing the sugar level to begin to rise again. We, and others, have used the combination of B-1, C and Cysteine to successfully abort severe attacks of hypoglycemia. A reasonable dose for a healthy adult is 5 grams of C, 1 gram of B-1, and 1 gram of Cysteine.”

So your recollection of 2 grams of Cysteine, and 6 grams of Vit C (a 1:3 ratio, versus their recommendation of a 1:5 ratio) is pretty close. To answer your specific question—Yes, I believe N-Acetylcysteine would have the same, if not even better effect than L-Cysteine.

However, and perhaps more importantly, is the question of why you are suffering from hypoglycemia? I’m wondering why you were following your blood glucose so closely, and how you were able to monitor it so accurately? Are you a diabetic, or do you have access to a glucometer from someone else? Were you taking any supplements or medications that might affect your blood sugar? How old are you? Do you have any lab values that would be helpful (i.e., Glucose levels before and after the hypoglycemic episode; and Hemoglobin A1c level); What (if any) medications you may be taking; Do you have any significant past medical history; How long have these hypo­glycemic episodes been occurring; and how many have you had?

We need to determine if the hypoglycemic episode(s) was purely due to reactive hypoglycemia due to a fast-acting pancreatic over-response to carbohydrate; are you a metabolic over-utilizer of glucose (i.e., does your body burn up glucose faster than your body can produce it via gluconeogenesis); or (the BIG question) do you have an undiscovered insulinoma (i.e., pancreatic beta cell tumor)?

As you are aware, a 50-point drop in blood sugar over 10 minutes is a pretty dramatic change. I think it’s very important to determine the cause (not just treat it symptomatically with Vit C, B-1 and N-Acetylcysteine, although that’s not a bad temporary solution). I suggest that you be evaluated by an endocrinologist, one who can determine your simultaneous blood glucose, insulin and cortisol levels. This will give an indication of what’s going on. For diagnosis, a detailed CT scan, MRI, an octreotide scan, and an endoscopic ultrasound are all helpful, although many cases are not definitively diagnosed until laparoscopic surgery is performed. Treatment for an insulinoma is usually surgical enucleation or partial resection of the pancreas.

Please get back to me with as many answers to the above questions as you can provide, and I’ll make whatever further recommendations I can.

Ward Dean, M.D.

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